Individual
ELLIE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3455 SW US VETERANS HOSPITAL RD, PORTLAND, OR 97239-3076
(503) 494-8311
Mailing address
2926 SW 4TH AVE APT 101, PORTLAND, OR 97201-4932
(925) 872-3484
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/25/2023
Last updated
09/25/2023
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